How does the title and subtitle (Riding the Bus with My Sister: A True Life Journey) influence your reading of the book? Does the fact that this is a true story written in the first person change the way you respond to the text? How might you read or respond differently if the author had chosen to write this as a novel instead of a memoir? 

How does the theme of writing show up in the book? Does writing intersect with power? For example, how much more power does Rachel have to raise awareness than Beth does? How do the examples of Beth’s writing, via her letters and cards, help us understand Beth more deeply? What do her written words expose and what do they leave out? 

Rachel grapples for a long time with the notion of self-determination. What is your understanding of self-determination after reading this book? What do you think about this concept? Do you agree with Rachel’s actions even though they sometimes violate the principles of self-determination, such as when she forces Beth to have a surgery that she doesn’t want?